"Medicine is a social science, and politics is nothing else but medicine on a large scale"—Rudolf Virchow

October 07, 2014

Nearly 300 times as many people are hospitalized with severe dengue infections in India as are officially reported by the government, according to a study published this week.

The study of the mosquito-borne disease, by researchers at Brandeis University in Massachusetts, is part of a growing body of literature demonstrating that no country in the world suffers as many dengue infections as India.

Officially, the Indian government reports that an average of about 20,000 people are hospitalized annually with dengue infections. The Brandeis study suggests that the real number of hospitalizations is closer to six million, and other studies have suggested that the actual number of Indians infected annually is probably more than 30 million.

“In absolute numbers of cases, we estimate that India has the highest absolute number of cases,” Dr. Donald S. Shepard of Brandeis University, a co-author of the study, said in an interview.

The study estimated that the direct and indirect costs of these hospitalizations exceeded $1 billion annually. The Brandeis study was funded by Sanofi Pasteur, which is in the midst of trials of a dengue vaccine. Sanofi Pasteur has a financial interest in suggesting that dengue’s reach and costs are high, but investigators said that Sanofi Pasteur had no control over the conduct of the research.

The study’s methodology, which focused on only one state in its clinical assessments and included broad assumptions about how patients seek care and are tested for the virus, probably underestimated the actual burden of the disease, Dr. Shepard said.

Government officials have long acknowledged that official data vastly underestimates the burden of the illness, but they explain that any change in the system would impede year-to-year comparisons. That the annual dengue epidemic coincides with the beginning of India’s busiest tourist season may also play a role in the government’s decision making.

As Oscar Wilde might say, suffering 20,000 dengue case may be considered a misfortune; suffering 6 million begins to look like carelessness. And 30 million begins to look like policy.

October 06, 2014

One reason why I hate Ebola is that it keeps me from posting about other serious outbreaks. So just to spite the stupid virus, here's an item from South China Morning Post: Dengue fever cases top 21,000 in Guangdong. Excerpt:

The number of cases of dengue fever in Guangdong has doubled in just over a week.

Twenty cities in the province had reported 21,527 cases by midnight on Sunday, according to figures released by the provincial health department.

The authorities had reported 10,743 cases on September 27.

Six people have died of the disease.

Guangzhou officials pledged about a fortnight ago to contain the outbreak in about "two to three weeks" with stronger eradication measures, but the rise in infections of the mosquito-born virus is showing no sign of easing.

Xinhua warned last week that if Guangzhou and other key cities failed to contain dengue fever in the next month or two, the outbreak will further escalate and spread to other regions, describing it an "extremely challenging prevention effort".

Dengue fever can cause a skin rash similar to measles, headaches, and muscle and joint pain. A small number of sufferers develop a life-threatening haemorrhagic fever, or dengue shock syndrome, in which blood pressure drops dangerously low.

The number of dengue fever cases reported so far this year is about five times higher than in the same period last year. Five of the six who have died are from Guangzhou.

Guangzhou is a major part of the Pearl River Delta urban sprawl, which Wikipedia tells us now includes about 40 million people. It's a hot, humid, rainy region, and a mosquito utopia. Exhorting the governments involved won't do much; it'll take a relentless public campaign.

Too bad Mao didn't single out Guangdong mosquitoes back in the days when he was waging misguided campaigns against sparrows as thieves of the people's grain—and people wiped out sparrows.

September 28, 2014

A low-priced device that can collect up to 500 mosquitoes in three hours and was developed by a former university professor in Nagoya has been drawing keen attention amid the spread of dengue fever in Tokyo parks.

The only way to curb infections is to reduce the number of mosquitoes, said Kenzo Iwao, a former professor of bioenvironmental engineering at the Nagoya Institute of Technology.

“I hope the trap can be placed at spots where people gather,” he said.

The black, triangular-shaped device measures about 40 cm long and is made from waterproof plastic cardboard. To a mosquito, the shape of the device resembles a crouched dog or cat.

It has a replaceable adhesive sheet attached to its surface that emits a smell similar to animals or human beings, drawing and trapping mosquitoes.

Iwao has been working to develop a mosquito-collecting device for more than 20 years, following a request from the Thai government.

His prototype did not sell well, as it was priced at as high as ¥100,000 [US$913]. But the latest version, Iwao’s fourth-generation device, costs an affordable ¥3,000 [US$27] and can be handled easily.

A firm established by the Nagoya Institute of Technology started selling the device on Aug. 1. It has drawn attention, selling 500 units to a variety of customers, including homes, kindergartens, factories and shrines.

September 23, 2014

A deadly outbreak of dengue fever in Guangdong has spiked alarmingly in the last week, with 1,200 cases alone reported in Guangzhou between Saturday and Monday.

In all, the province has reported 6,089 cases this year - or 10 times more than same time last year.

The provincial capital is the hardest-hit area, with 5,190 cases, or 85 per cent of the total, and two deaths as of Monday, according to the Guangdong Provincial Centre for Disease Control and Prevention.

Yang Zhicong, deputy chief of the CDC's Guangzhou arm, said the authorities attributed the sudden spike in dengue to imported cases and persistent rainfall in the region.

He also said the refusal of many members of the public and even government bodies to cooperate contributed to the high number. This included Guangzhou Zoo, which refused to let Yang's office monitor mosquitoes inside its premises, according to local media reports.

Yang said the authorities had established 177 monitoring stations for mosquitoes from the Aedes genus known to spread the dengue virus.

The two dengue deaths, both elderly patients, were the first reported in the city for many years, said Yin Zhibiao , head of Guangzhou's Eighth People's Hospital, an infectious disease facility that has admitted 199 patients with dengue fever, 15 of whom were "severely ill".

The China News Service quoted Yin as saying the two deceased patients had high blood pressure and diabetes.

Mosquitoes were a big problem when my family and I lived in the outskirts of Guangzhou in 1983. We didn't know their names, but we had a lot of them. Some were silent; you knew they'd struck only when your ankles started itching. One species, which our students called "bombers," were huge but slow enough to grab out of the air. Sleeping under mosquito nets was an absolute necessity, and the night when mine came out of its ceiling hook was not a happy one.

Venezuelan Health Minister Nancy Pérez said that to date no cases of Ebola have been recorded in the country, radio station Unión Radio reported.

She remarked the cases of the eight deaths in Maracay Central Hospital (HCM), central north Aragua state, have no relationship to each other. Further, based on the autopsies, she claimed the results show no "strange disease." The cases had been previously linked to a suspected outbreak of Ebola or chikungunya fever in the Maracay Central Hospital.

"The cases in Aragua state, and doctors know this, have no time or spatial connection to each other. Underlying diseases were found: a cancer patient who had complications and he died. A child who was 17 days and had a plant poisoning that led to a hypovolaemic shock (...) The autopsies show that in the eight cases there was no ‘rare disease,'" said Pérez.

I would have guessed hemorrhagic dengue. Eight fatal cases of chikungunya would have been statistically unlikely, but I'll take the health minister's word. In a country as economically and politically stressed as Venezuela, a kindergarten full of runny noses could set off a health alert.

For the first time in history the country has recorded transmission of the chikungunya virus on Brazilian territory. Chikungunya fever, known as "dengue's cousin," is also transmitted by the Aedes aegypti and Aedes albopictus mosquitoes.

According to a statement by the Ministry of Health this Tuesday (16th), two cases—a father of 53 and his 31-year-old daughter—were confirmed in Oiapoque, Amapá state, and everything indicates that they are not imported cases.

September 09, 2014

Japan had been free of dengue fever since 1945, but that streak is now over. More than 60 Japanese have come down with the disease since the end of August.

Dengue is a viral infection transmitted by types of mosquitoes normally found in tropical and subtropical climates. Symptoms include high fever, severe headache, muscle and joint pains, nausea, swollen glands and rash. Most patients recover, but there is the possibility of deadly complications; dengue is a leading cause of death among children in parts of Asia and Latin America.

There is no immunization or specific treatment for dengue fever. There is, however, hope. A recent article by Andrew Pollack in The New York Times reported that an experimental vaccine developed by Sanofi proved about 60 percent effective in a large clinical trial involving more than 20,000 children ages 9 to 16 in several countries in Latin America and the Caribbean.

The outbreak in Japan is yet another reminder of the dangerous consequences of global warming. At a recent conference in Geneva, the World Health Organization warned of increases in dengue fever and other climate-sensitive diseases in unexpected parts of the world.

Higher temperatures and humidity cause mosquitoes to live longer and enlarge the geographic areas where they can spread the disease. While only nine countries experienced severe dengue before 1970, the disease is now endemic in more than 100 countries. Malaria, another mosquito-borne infection, is also on the rise. Health authorities have closed and fumigated parks in Tokyo where infected mosquitoes were found.

Perhaps, too, Japan will be inspired to review and strengthen its policies on global warming. With a United Nations conference on climate change only weeks away, an ambitious commitment by the Japanese government to reduce emissions of carbon dioxide and other greenhouse gases would be decidedly welcome.

According to Dr. Jorge Luis Quiñones Aguilar, chief of the provincial department of health promotion and education, the patients contracted the disease in Haiti while serving as doctors in the Caribbean country.

September 08, 2014

The ECDC Communicable Disease Threats Report is a weekly bulletin intended for epidemiologists and health professionals in the area of communicable disease prevention and control. This issue covers the period 31 August–6 September 2014 and includes updates on:

Ebola virus disease – West Africa

An outbreak of Ebola virus disease (EVD) has been ongoing in West Africa since December 2013, affecting Guinea, Liberia, Sierra Leone and Nigeria. The overall situation of the Ebola outbreak in the affected countries remains critical. As of 31 August 2014, 3 707 cases including 1 848 deaths have been reported from the affected countries. Two-hundred and fifty-seven of the cases occurred in healthcare workers including 140 of the deaths. ECDC published a rapid risk assessment on 4 September 2014

Ebola virus disease – Democratic Republic of Congo

On 24 August 2014, an outbreak of Ebola virus disease (EVD) was declared in the Boende health zone of Equateur province in the Democratic Republic of Congo. This outbreak is the seventh outbreak of EVD occurring in the country. During the past week, 30 new cases and 35 deaths were reported from the affected area. Seven of the cases, including six deaths, are healthcare workers.

Dengue fever

On 27 August 2014, the Japanese Ministry of Health reported the first locally-acquired case of dengue fever in the country in nearly 70 years. As of 5 September, 66 autochthonous cases of dengue fever have been reported in Japan. None of the cases have recent overseas travel history and all cases visited Yoyogi Park, in Tokyo, in August.

Monophasic Salmonella typhimurium MLVA clusters

Two related clusters of monophasic Salmonella Typhimurium were detected through the European Surveillance System moleculartyping surveillance system in August. Thirty-eight cases with this previously unseen and closely related MLVA pattern were detected in six countries for the first time in 2014. ECDC published a rapid outbreak assessment on 5 September 2014

September 04, 2014

The 19 year old undergraduate student of Law in Ahmadu Bello University (ABU), who has been under quarantine at the teaching hospital of the University in Shika, Zaria for a strange ailment that was earlier suspected to Ebola Virus Disease (EVD) has been tested Ebola negative.

Bajoga, who is the Chairman, Kaduna State Ebola Prevention and Control Committee said, “just as I told you about my doubt on the Ebola issue, I am happy to inform you that the result of the sample of the patient’s blood taken to a Lagos laboratory, came back this morning. The young man was negative of the Ebola virus.

“However, the patient was tested positive for Dengue fever. I am told it is a very bad type of fever, but it is no where close to the Ebola virus. May I reassure our people that we ever ready to contain any outbreak of Ebola.

And for now, and I pray forever, there is no single case of Ebola in Kaduna state."